Text Messaging Self-Reports: A Useful Approach for Assessing PrEP Adherence in MSM

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Patients with higher self-reported adherence following text messaging reminders had higher PrEP drug concentrations.

Men who have sex with men with higher self-reported adherence following text messaging reminders for pre-exposure prophylaxis (PrEP) had higher drug concentrations, according to a study published in The Journal of Infectious Diseases. Furthermore, minority race and younger age were associated with lower rates of self-reported adherence via text and higher levels of substance use, sexual risk, and depression.

The 181 participants, age 18 or older, were part of an open-label clinical demonstration project and had been randomly assigned to the text messaging arm of the study.

This 48-week study’s primary aims were to identify PrEP adherence trajectories for men who have sex with men who received adherence texts over the course of the study, to examine factors related to patterns of adherence, and to examine attitudes toward the text-message intervention and PrEP.

A supplementary aim of the study was to examine the efficacy of using text messaging as an ecological momentary assessment tool for measuring PrEP adherence.

Over the 48 weeks of the study, all patients received once-daily oral tenofovir disoproxil/emtricitabine, adherence and risk reduction counseling, and safety monitoring. Patients in the text messaging arm also received text messages at intended dosing times, to which they could respond A) took, D) didn’t take, or G) snooze.

If a patient responded G, they would get a reminder text 1 hour later. Patients reported medication adherence on 85.1% of days, non-adherence on 0.08% of days, and did not respond on 14.1% of days. Overall, the text message participants showed significantly higher drug concentrations that correspond to high levels of adherence.

Compared with the highest adherence group within the text messaging arm of the study, the lowest adherence group participants were more likely to experience depression (odds ratio [OR], 1.111; =.039) and substance use disorders (OR, 1.373; =.005) and were also more likely to be minority race (OR, 3.842; =.032).

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Study investigators conclude that the study “demonstrates text-messaging as a useful approach for capturing longitudinal adherence among HIV-uninfected [me who have sex with men]. Future research should investigate the association of adherence trajectories with dynamic, and more frequently assessed, correlates in order to better understand PrEP adherence in the context of high-risk sexual behavior.”

This study was supported by the California HIV Research Program. The study drug and research supposed was provided by Gilead Sciences. Please refer to reference for a complete list of authors’ disclosures.


Pasipanodya EC, Jain S, Sun X, et al; for the California Collaborative Treatment Group (CCTG) TAPIR Study Team. Trajectories and predictors of longitudinal PrEP adherence among men who have sex with men [published online June 22, 2018]. J Infect Dis. doi: 10.1093/infdis/jiy368